What is a Hammertoe?

A hammertoe is a deformity or contracture that usually occurs to one or several of the smaller toes.  There are different types of hammertoes depending on the specific joints that are contracted.  These include hammer toes, claw toes, and mallet toes.  Occasionally a similar contracture of the big toe can occur, called hallux malleus.  Most hammertoes develop over time as we age, but some can be congenital.  In particular the fourth toes are susceptible to a condition called curly toe seen at birth.  Hammertoes usually start off being flexible where the toe can be manually straightened but may become rigid in a fixed position over time.

What causes Hammertoes?

Hammertoes are caused by a muscle imbalance.  There are tendons on the top of the toes called extensor tendons and on the underside of the toes called flexor tendons.  If one of those tendons pulls harder than the other it can lead to contracture of the toe.  Some common causes are:

• Congenital/Hereditary
• Shoes that are too tight and constricting
• Neuromuscular conditions such as strokes
• Trauma or injury to the bones or tendons in the toe
• Pressure from a bunion pushing against the smaller toes
• Peripheral neuropathy from diabetes
• Some arthritic conditions like rheumatoid arthritis
• High arched feet, called pes cavus

Symptoms of Hammertoes

• Crooked or contracted toes leading to redness, irritation, and pain on top of the toe knuckle or the tip of the toe
• Corns may form on pressure points from shoes
• If friction is severe enough, blisters or even open wounds called ulcers may form. This is common in diabetics.  These can easily become infected.

Non-Surgical Treatment of Hammertoes

Wearing shoes with a roomy toe box is helpful to reduce pressure on the toes.  Sometimes special shoes called extra depth shoes with a deep toe box are needed.  Stretchable fabric shoes made from materials such as Lycra can lessen the pressure.  There are many types of pads that may help cushion the toes including foam or silicone tube pads and crest pads.  Trimming the corns can be performed by your podiatrist.  We do not recommend chemical corn remover pads.

Surgical Treatment of Hammertoes

If conservative methods fail there are ways to help permanently straighten the toes.  An office based procedure called a tenotomy can be done to release the contracted tendon(s).  This is particularly effective for diabetics with flexible hammertoes that have developed ulcers or infection.  This usually requires a single suture and causes minimal pain.  However, if the hammertoes are rigid, then some type of bone procedure is typically needed and would likely be performed at a surgery center or hospital.  Most often this requires fusion (aka arthrodesis) of the contracted joint.  A pin is often placed in the toe for several weeks while it heals and a special boot or shoe is worn during that time.  Please contact us if hammertoes are causing you pain.